With Cardiologist Chippy Ajithan, MD
For decades, a daily regimen of low-dose aspirin has been promoted as a safe and effective way for people over the age of 50 to lower their risk of heart attack, stroke and other cardiovascular problems.
But over the past few years, the US Preventive Services Task Force has been taking another look, weighing the potential benefits against the potential risks and making some important changes. Here’s a quick rundown of what’s known and what’s new, but remember to always talk to your healthcare provider before starting or stopping any medication.
The Benefits of Daily Asprin
As a natural blood thinner, aspirin can be a helpful tool in managing cardiovascular disease and reducing risk of heart attack, stroke and other problems caused by harmful blood clots. For this reason, the USPSTF, the American Heart Association and physicians around the world have recognized the potential benefits of taking daily aspirin in low doses, for those aged 50-69. This is especially true for those who have already had a heart attack or stroke or been diagnosed with a vascular disease, as the benefits of a daily aspirin regimen for secondary prevention have been well established.
In addition, studies have shown that taking low-dose aspirin on a near-daily basis can help slow the spread of colorectal cancer, if the regimen is preventative and begun prior to diagnosis. However, recent research has suggested that the potential benefits may not outweigh the potential risk in every case, especially as one gets older.
Potential Risks of Daily Asprin
Should I Still Take Aspirin If I Think I’m Having A Heart Attack?
“Absolutely,” says Dr. Ajithan. “Take an adult dose aspirin, 325 milligrams, and chew it for 30 seconds, then swallow. A heart attack involves a mix of red clot and white clot, and you want to inactivate that white clot, called platelets. The fastest way to do that is to chew an aspirin.
“Don't just swallow it with water, and be sure it’s not coated.”
The same blood-thinning capability that makes daily aspirin beneficial for those concerned about harmful blood clots also has the potential to make certain bleeding disorders worse. In particular, the USPSTF found that a daily aspirin regimen could increase the risk for gastrointestinal bleeding, intracranial bleeding and even hemorrhagic stroke. This risk increases as the person ages, and becomes more pronounced after age 60.
Newer studies also indicated that, despite its potential benefits slowing colorectal cancer in younger patients, daily aspirin use was associated with higher incidence of colorectal cancer in those over age 70.
Given these new findings, the latest guidance from the USPSTF makes some significant changes from previous recommendations.
The New Recommendation
The previous recommendation from the USPSTF advised a daily regimen of low-dose aspirin for those ages 50-59, and who have increased risk of cardiovascular disease and are not at increased chance of bleeding. For those age 60-69, the USPSTF reserved judgment, saying it was an individual choice with potential benefits, and should be discussed with a doctor.
The new recommendation makes important changes for both age groups.
- A low-dose daily aspirin regimen can be beneficial for those age 40-59, who have increased risk of cardiovascular disease, but the decision should be made on a case-by-case basis, looking at each individual person’s unique health and their doctor’s advice. It is no longer a blanket recommendation.
- The USPSTF now recommends against initiating a low-dose aspirin regimen for those 60 years and older, citing increased risk of bleeding and no net benefit.
But far from being dismayed at the news that daily aspirin might not be all that we once thought it was, the change in recommendation can also be seen as a result of improvements in other areas of medicine, according to Dr. Chippy Ajithan.
Blood pressure medications, statin therapy and diabetes medications have all improved to the point that they contribute to overall cardiovascular health in a way that has largely made an aspirin regimen obsolete for some. In other words, patients may not need any of the potential risks that come with a daily aspirin regimen, because they’re already getting all the benefits from other medications.
“The reduction in risk resulting from better hypertension, hypercholesterolemia and diabetes management seems to supersede the benefit of aspirin, while avoiding possible increased risk of colon cancer,” says Dr. Ajithan. “These factors, along with increased risk of bleeding, have shifted the balance on aspirin.”
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